This is a revised competing renewal proposal for a Midcareer Investigator Award in Patient- Oriented Research (K24) for Christopher M. Callahan, MD. This proposal requests an additional five years of support (Years 06-10). The first five years of funding were successful and the candidate met or exceeded each of the targeted goals for that award. Dr. Callahan is a physician-scientist whose research focuses on improving the clinical care of older adults. His specific research interests are in dementia and late life depression and improving quality of care for these conditions among older adults in primary care settings. Dr. Callahan is a Professor of Medicine at the Indiana University School of Medicine and the founding Director of the Indiana University Center for Aging Research. The purpose of this Award is to allow the candidate to build his capabilities in aging-related patient-oriented research and to support his role as a mentor for junior faculty and to develop his role as mentor for a growing number of "next generation" mentors. The candidate is proposing to extend the research laboratory at the Center of Aging Research to target a larger segment of the continuum of care, including the nursing facility setting. The specific aims for years 06-10 of the K24 are to: 1. Train the next generation of physician-scientists and behavioral scientists in patient-oriented research to improve the care provided to older adults across the continuum of care; 2. Exploit existing clinical practice and clinical trial data by combining these data with longitudinal state-level data describing utilization of nursing facility care;and 3. Re-invigorate the candidate's pursuit of R01-type funding in support of clinical trials that expand the targets of the intervention beyond the walls of primary care. Most older adults are cared for in primary care settings and the candidate remains committed to improving care in this setting. However, strategies to improve care for older adults must increasingly take into account other sites of care, such as that provided in nursing facilities and in the patient's home. PUBLIC HEALTH RELEVANCE: The project has two goals. The first goal is to increase the nation's capacity to conduct patient-oriented research by increasing the number of physician-scientists trained in clinical research relevant to older adults. The second goal is to expand the Candidate's scope of research by studying clinical interventions that account for the multiple health care providers and sites of care involved in delivering care to older adults, including nursing facilities.